Objective: To map the available evidence regarding the extra-esophageal manifestations of gastroesophageal reflux disease (GERD) in adults, summarize the reported clinical presentations, diagnostic approaches, and management strategies, and identify knowledge gaps requiring further investigation. Methodology: This scoping review was conducted from February to April 2026 at Midway Medical Clinic, Panama City, Florida, USA, following the Arksey and O'Malley framework, Levac et al. refinements, JBI guidance, and PRISMA-ScR reporting recommendations. A literature search was performed from 7 to 21 February 2026 using PubMed/MEDLINE as the primary database and Google Scholar as a supplementary source. English-language studies involving adults (≥18 years) and published between January 2000 and December 2025 were considered eligible. Records were screened according to predefined eligibility criteria, relevant data were charted using a standardized extraction form, and findings were synthesized descriptively. Results: The database search identified 194 records from PubMed and two additional records through Google Scholar. Following screening and eligibility assessment, 50 studies were included in the evidence synthesis. Representative studies were selected for detailed evidence mapping to minimize redundancy while ensuring comprehensive coverage of the available literature. Laryngopharyngeal reflux, chronic cough, hoarseness, chronic throat clearing, asthma, chronic rhinosinusitis, and obstructive sleep apnea were the most frequently reported extra-esophageal manifestations, whereas upper gastrointestinal endoscopy demonstrated limited diagnostic utility in patients presenting exclusively with extra-esophageal manifestations. Considerable heterogeneity was observed in study design, diagnostic criteria, reflux assessment methods, and reported outcomes. Conclusion: Extra-esophageal manifestations represent an increasingly recognized but diagnostically challenging component of GERD. Current evidence supports multidisciplinary assessment and the selective use of objective reflux testing in patients with persistent atypical symptoms. Standardized diagnostic criteria and well-designed prospective studies are required to strengthen the evidence base and optimize the diagnosis and management of extra-esophageal GERD.
Objectives: To evaluate the clinical outcomes and safety of vincristine, topotecan, and cyclophosphamide as salvage chemotherapy in children with relapsed or refractory intraocular retinoblastoma. Methodology: A retrospective cohort study was conducted including children with relapsed or refractory intraocular retinoblastoma treated with vincristine, topotecan, and cyclophosphamide (VTC) salvage chemotherapy between January 2020 and December 2025 at the Children Eye Hospital, Al-Shifa Trust Eye Hospital Rawalpindi, Pakistan. Outcomes were analyzed at both the patient level (n=47) and eye level (n=78), as appropriate. The primary outcome was globe salvage. Secondary outcomes included treatment-related toxicity and overall survival. Kaplan–Meier survival analysis was performed to estimate overall survival. Results: A total of 47 patients (78 eyes) were included. Globe salvage was achieved in 46/78 eyes (59%; 95% CI 47.4%–69.8%). Outcomes varied by disease stage, with salvage rates of 100% in Group B, 70% in Group D, and 38% in Group E eyes. Increasing prior chemotherapy exposure was associated with lower salvage rates. Adjunctive focal therapies and intra-arterial chemotherapy were used in selected cases and were considered potential confounding factors during analysis. Febrile neutropenia occurred in all patients; however, no treatment-related mortality was observed. Despite frequent hematologic toxicity, adverse events were manageable with supportive care and treatment modifications when required. At 30 months, Kaplan–Meier estimated overall survival was 95.7%. Conclusion: VTC salvage chemotherapy demonstrated clinically meaningful activity in children with relapsed or refractory intraocular retinoblastoma, with an acceptable and manageable toxicity profile. Treatment outcomes were influenced by disease stage and prior chemotherapy exposure, with better globe salvage observed in less advanced and less heavily pretreated disease. In resource-constrained settings where access to advanced focal therapies remains limited, VTC may serve as a practical salvage treatment option. Further prospective multicenter studies are required to better define its role within contemporary retinoblastoma treatment strategies.
Objective: To determine the prevalence of cognitive impairment and describe cognitive performance among patients with rheumatoid arthritis attending a tertiary care hospital in Pakistan. Methodology: This descriptive cross-sectional study was conducted at the outpatient department of Aziz Fatimah Hospital, Faisalabad, Pakistan, from June to September 2025. A total of 242 adult patients diagnosed with rheumatoid arthritis according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria were recruited through convenience sampling. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) with Urdu translation assistance during administration. Cognitive impairment was defined as a MoCA score of 27 or less. Descriptive statistics were used to summarize participant characteristics and cognitive performance. Results: The mean age of participants was 44.93 (SD 13.80) years, and 158 (65.3%) were female. The mean total MoCA score was 22.65 (SD 4.42). Cognitive impairment was identified in 172 participants, corresponding to a prevalence of 71.1%. Analysis of individual cognitive domains demonstrated lower performance in delayed recall (2.78, SD 1.46), executive functioning (3.24, SD 1.48), and abstraction (1.30, SD 0.75), whereas orientation showed the highest mean score (5.20, SD 1.12). Conclusion: Cognitive impairment was highly prevalent among patients with rheumatoid arthritis, affecting more than two-thirds of the study population. Delayed recall, executive functioning, and abstraction were the most affected cognitive domains. Routine cognitive screening may facilitate early identification of cognitive dysfunction and support comprehensive management of patients with rheumatoid arthritis.
Objective: Core needle biopsy often underestimates ductal carcinoma in situ (DCIS), which leads to the detection of invasive cancer only at surgery. The objective of this study is to identify the frequency and factors associated with upstaging, which can improve surgical planning and patient counseling. Methods: In this retrospective cohort study, 131 female patients aged 20-60 years diagnosed with unilateral pure DCIS on core needle biopsy at Jinnah Postgraduate Medical Centre, Karachi (January 2022-December 2023), were included using non- probability consecutive sampling. Patient records were reviewed to extract demographic, reproductive, pathological, and radiological information, including immunohistochemistry for estrogen receptor, progesterone receptor, and HER2. Statistical analysis was performed using SPSS version 20. Upstaging to invasive breast cancer was assessed, and associations were analyzed using chi-square or Fisher’s exact. The threshold of p-value was set to <0.05. Results: Out of 131 females diagnosed with DCIS on core needle biopsy, 40 females (30.5%) were found to have upstaged to invasive cancer based on surgical pathology. The factors that showed significant association with upstaging were shorter symptom duration (p=0.04), lower parity (p=0.01), higher gravidity (p=0.01), PR positivity (p=0.01), tumor size <2 cm on ultrasonography (p=0.01), and absence of mammographic calcifications (p=0.04). Age, ER status, HER-2 status, family history, margin status, and mammographic architectural distortion showed no significant association. Conclusions: Nearly one-third of patients with ductal carcinoma in situ were upstaged to invasive carcinoma, highlighting the potential relevance of integrating clinical, hormonal, and imaging characteristics during preoperative assessment.
Objective: To compare the efficacy of intra-articular platelet-rich plasma (PRP) combined with corticosteroid versus corticosteroid alone in patients with Kellgren–Lawrence grade 2–3 knee osteoarthritis. Methodology: This clinical interventional study included 50 patients with radiographically confirmed knee osteoarthritis. Participants received either intra-articular PRP combined with methylprednisolone acetate and lignocaine or methylprednisolone acetate with lignocaine alone. Eleven patients were lost to follow-up, leaving 39 patients for analysis. Outcomes were assessed at baseline and monthly for three months using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS). Results: Thirty-nine patients completed the study (mean age 56.1±4.7 years; 61.5% female). Compared with corticosteroid alone, the PRP plus corticosteroid group demonstrated significantly greater improvement in WOMAC pain (p=0.012), WOMAC stiffness (p=0.048), and VAS pain scores (p=0.027). Improvement in WOMAC functional limitation was not significantly different between groups (p=0.194). Although the intervention group showed greater reduction in total WOMAC score, the between-group difference did not reach statistical significance (p=0.067). No significant differences were observed according to Kellgren–Lawrence grade, and no adverse events were reported. Conclusion: PRP combined with corticosteroid was associated with greater improvement in pain and stiffness than corticosteroid alone in patients with grade 2–3 knee osteoarthritis. Although the primary outcome (total WOMAC score) did not differ significantly between groups, the combination therapy demonstrated favourable effects on several secondary outcomes and may provide a more sustained symptomatic response. Larger studies with longer follow-up are needed to confirm these findings.
Objective: To determine if alterations in cephalic vein diameter, after the application of a manual tourniquet, could serve as a prognostic marker for the early maturation of autologous below-elbow arteriovenous fistulas (AVFs) among individuals with stage 5 chronic kidney disease (CKD). Methodology: Between January 2024 and March 2025, this prospective observational study was carried out at the Vascular Surgery Department at Holy Family Hospital, Rawalpindi Medical University. The study recruited adults diagnosed with stage 5 CKD who were scheduled for below-elbow AVF construction. To record the cephalic vein diameter, duplex ultrasonography was used both before and after a two-minute application of a tourniquet. Based on the results, subjects were divided into a distensible group (diameter increase ≥ 0.5 mm) and a non-distensible group (diameter increase < 0.5 mm). After a six-week period, fistula maturation was determined by applying the Rule of 6s (vein diameter more than 6 mm, depth less than 6 mm, and blood flow more than 600 mL/min). Results: Out of the 120 subjects, successful AVF maturation at the six-week mark was observed in 85% of the distensible cohort, compared to only 63.6% in the non-distensible cohort (P = 0.046). Also those in the distensible category had a notably reduced HbA1c levels (p = 0.0002). No statistically significant variances were noted between the two groups regarding patient age or arterial dimensions. Receiver operating characteristic (ROC) evaluation indicated a moderate predictive capability, having area under the curve (AUC) of 0.60 (95% CI: 0.50–0.70). A post-tourniquet venous expansion of ≥0.5 mm indicated a positive correlation with early AVF maturation. Conclusion: This simple test may serve as a low-cost adjunct to preoperative assessment, particularly in resource-constrained healthcare settings.
Objective: To compare perceived stress levels between hostel-residing and day-scholar medical students and evaluate the association between mobile screen time and perceived stress. Methodology: An analytical cross-sectional study was conducted from August to December 2025 in public and private medical colleges of Lahore, Pakistan. A total of 476 undergraduate medical students owning smartphones were recruited through convenience sampling. Average daily mobile screen time was recorded using Google Digital Wellbeing or Apple Screen Time applications. Perceived stress was assessed using the validated Perceived Stress Scale (PSS-10). Data were analyzed using descriptive statistics, independent samples t-test, Pearson correlation, Chi-square test, and logistic regression analysis. Results: Moderate stress was the most frequently reported category among both hostel-residing students and day scholars. Mean PSS-10 scores did not differ significantly between hostel-residing students (18.8 ± 5.5) and day scholars (18.1 ± 5.4; p = 0.31). Students reporting screen time exceeding two hours per day demonstrated higher levels of moderate to high stress across both residential groups. Daily screen time showed a weak but significant positive correlation with perceived stress (r = 0.28, p < 0.001). Students with screen time >2 h/day had more than twice the odds of experiencing high stress compared with those reporting ≤2 h/day (OR = 2.25, 95% CI: 1.15–4.42). Conclusion: Perceived stress was highly prevalent among undergraduate medical students irrespective of residential status. Higher mobile phone screen time was associated with increased stress levels, suggesting that digital exposure may represent an important modifiable factor influencing student well-being. Strategies promoting healthy digital habits and stress management may help improve psychological well-being among medical students.
Objective: To evaluate clinical and patient-reported outcomes of microfat injections for facial skin rejuvenation using clinical and patient-reported outcome measures. Methodology: This prospective single-arm interventional study was conducted from January to June 2024 at Halcyon Medical Center, Lahore, Pakistan. Thirty adults (21 females, 9 males) aged 30–60 years presenting with facial wrinkles, pigmentation, skin laxity, or under-eye bags were enrolled. Patients with uncontrolled systemic disease, autoimmune disorders, active infections, or recent facial aesthetic procedures were excluded. All participants received a single session of microfat injection and were followed for six months. Wrinkle severity and skin laxity were assessed using the Modified Fitzpatrick Wrinkle Scale (MFWS) and Merz Aesthetics Scale (MAS), respectively. Pigmentation was evaluated through physician assessment, while patient satisfaction was measured using the Global Aesthetic Improvement Scale (GAIS). Data were analyzed using the Wilcoxon signed-rank test. Results: Thirty adult patients were included in the study, comprising 21 females (70%) and 9 males (30%). Significant improvement was observed in wrinkle severity, with mean Modified Fitzpatrick Wrinkle Scale scores improving from 3.1 ± 0.6 to 1.7 ± 0.5, skin laxity with Merz Aesthetics Scale scores improving from 2.2 ± 0.4 to 1.1 ± 0.3, and pigmentation scores improving from 2.8 ± 0.5 to 2.3 ± 0.4 (all p < 0.001). On the Global Aesthetic Improvement Scale, 26 patients (86.7%) reported improvement, while 4 (13.3%) reported no change. No procedure-related complications or adverse events were observed during the six-month follow-up. Conclusion: Microfat injections demonstrated promising improvement in facial skin quality with high patient satisfaction and a favourable safety profile, supporting its role as a minimally invasive regenerative modality in facial rejuvenation.
Objective: To evaluate the results of a staged treatment approach for patients with severe hemoptysis. First, Bronchial Artery Embolization (BAE) is used to stop the acute bleeding, and once the patient is stable, surgical resection of the aspergilloma is done. Methodology: A retrospective observational study was conducted of 106 patients treated for moderate-to-massive hemoptysis secondary to invasive fungal lung disease at Services Hospital, Lahore, Pakistan, between January 2015 and June 2025. All patients BAE for hemostatic control. Those remaining stable were managed conservatively, while patients with recurrent bleeding or localized disease underwent delayed lobectomy after stabilization. Outcomes assessed included clinical success of BAE, recurrence, surgical morbidity, and mortality. Results: Technical and clinical success rates were 99.1% and 95.3%, respectively, with minor complications in 10.4% and no procedure-related mortality. Recurrent hemoptysis occurred in 27 patients (25.5%), and 44 patients (41.5%) subsequently underwent delayed lobectomy after clinical stabilization. At a mean follow-up of 18.2 months, 93 patients (87.7%) remained alive and free of recurrent hemoptysis. Kaplan–Meier estimated 1-year recurrence-free survival and overall survival were 89.6% and 95.3%, respectively. Bilateral disease and massive hemoptysis at presentation were independent predictors of recurrence, while recurrent hemoptysis was the strongest predictor of progression to delayed surgical intervention. Conclusion: In patients with life-threatening hemoptysis due to aspergilloma or invasive fungal lung disease, BAE appears to provide effective short-term bleeding control with acceptable complication rates. In selected patients, a staged approach consisting of initial BAE followed by delayed lobectomy when clinically indicated may be a feasible and safe management strategy. Keywords: Bronchial artery embolization; Lobectomy; Hemoptysis; Aspergilloma; Invasive fungal lung disease; Staged management.
Objective: To compare the frequency of postoperative scrotal hematoma between single-incision scrotal orchidopexy (SISO) and traditional two-incision inguinal orchidopexy (TTIO) in children with palpable undescended testis. Methods: A randomized controlled trial, including 540 male children with palpable undescended testis, was conducted at the Department of Pediatric Surgery, Children Hospital Faisalabad, between May and November 2025. Using random sampling, 540 male children between 1 and 10 years of age with palpable undescended testis were recruited and randomized into two groups (n=270) via computer based random number table. Group A was operated with SISO and group B with TTIO. The primary outcome measure was scrotal hematoma clinically observed within 72 hours. Statistical analysis was done using SPSS 25. Chi-square test was used to compare proportions, and Risk Ratios (RR) with 95% confidence intervals were calculated. Results: The mean age was 5.43±2.90 years in Group A and 5.50±2.99 years in Group B. Scrotal hematoma occurred in 11 (4.1%) patients in Group A and 32 (11.9%) in Group B (p=0.001). The RR of hematoma was significantly decreased with single-incision approach (RR=0.34; 95% CI: 0.18-0.64).
The FIFA World Cup is watched by billions as a celebration of sport, passion, and national identity. Yet beyond the stadium lights lies a highly disciplined system shaped by professionalism, accountability, teamwork, strategy, performance analysis, leadership, and preparation under pressure. Strikingly, many of these same principles form the foundation of medical education and healthcare practice. This special communication explores ten transferable concepts medical educators may embrace from football, including the graded management of unprofessional behaviours through card systems, the role of VAR-inspired documentation in accountability, strategic team formation, the emergence of performance metrics, coaching beyond traditional supervision, the rehearsal of high-pressure clinical scenarios through structured routines, and more. Selected elite football concepts and terms, such as squad rotation, loan spells, scouting, set-pieces, and shadow play simulation, will be decoded and used to solve critical problems in medical education. By drawing conceptual parallels between football and healthcare, this article encourages educators to move beyond conventional educational frameworks and embrace pattern thinking: the ability to recognize transferable principles across seemingly unrelated disciplines. Some of the most valuable lessons in medical education may emerge not only from classrooms, curricula, or textbooks, but also from observing how excellence, teamwork, discipline, and human performance are cultivated in other fields. Such reflections may inspire more thoughtful, accountable, and human-centered approaches to medical education and healthcare systems.
Artificial Intelligence (AI) is rapidly transforming the research landscape and is increasingly being used to support academic writing, literature exploration, data management, and scholarly productivity. In Health Professions Education (HPE) research, AI offers valuable opportunities to assist postgraduate students and researchers in understanding complex concepts, refining research questions, organizing information, improving language quality, and enhancing research efficiency. However, alongside these benefits, AI introduces important ethical, educational, and methodological challenges. AI-generated content may contain inaccuracies, fabricated references, inappropriate methodological recommendations, and superficial interpretations of complex educational phenomena. Excessive dependence on AI also risks undermining critical thinking, originality, scholarly identity formation, and authorship accountability. This editorial examines the responsible use of AI in HPE research and argues that AI should function as a supportive educational and scholarly tool rather than a substitute for human judgment, methodological rigor, or ethical responsibility. Practical applications, potential risks, and the responsibilities of students, supervisors, and academic institutions are discussed. Recommendations are provided to promote transparent, ethical, and accountable AI use in postgraduate research. As AI becomes increasingly embedded within academic practice, researchers must remain actively engaged in the scholarly process, ensuring that technology enhances rather than replaces human expertise and intellectual responsibility.
Objective: To assess the clinical presentation, management strategies, complications, and short-term patient-reported outcomes of craniofacial and skull-base FD at a tertiary neurosurgical center in a resource-limited setting. Methodology: A retrospective case series was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences Lahore between January 2018 and December 2024. Twenty-eight patients with histologically confirmed fibrous dysplasia were included. Data were analyzed using descriptive statistics, and the association between treatment modality and satisfaction was evaluated using Fisher’s exact test. Demographic data, anatomical distribution, presenting symptoms, treatment modality, complications and patient satisfaction were assessed by five-point Likert scale. Results: The mean age at presentation was 39 years (range: 8–54 years), with an equal sex distribution (1:1). The most common anatomical location was the ethmoid bone (93%), followed by the sphenoid and frontal bones (50% each). Orbital involvement was observed in all patients, and progressive visual deterioration and axial proptosis were the most frequent presenting features, followed by headache (50%) and trismus (7%). Patients were managed either by observation with diagnostic endonasal biopsy or by decompressive craniotomy with orbital decompression and were followed for six months. Two patients developed histologically confirmed malignant transformation. Twenty-two patients (78.6%) reported satisfaction with treatment outcomes, whereas six (21.4%) were dissatisfied. Conclusion: Craniofacial Fibrous Dysplasia in resource-limited settings, presents late with frequent orbital involvement. Symptom-directed surgical management was feasible with low short-term complication rates and acceptable patient-reported satisfaction; however, objective functional benefit remains uncertain because standardized visual outcome measures were not consistently available.
Objective: To assess the factors associated with dentin hypersensitivity and determine the relationship between tooth wear severity and dentin hypersensitivity among adult dental patients. Methodology: This cross-sectional questionnaire-based study was conducted from August 2022 to January 2023 at a public sector dental teaching hospital, affiliated with Dow International Dental College, Karachi, Pakistan. The patients were included through consecutive sampling visiting the outpatient Department of Operative Dentistry. Patient history and clinical examinations were evaluated to determine the factors contributing to dentin hypersensitivity. The severity of dentin hypersensitivity was measured using a Visual Analog Scale (VAS) while tooth wear was assessed clinically using the tooth wear index (TWI) developed by Smith and Knight. The statistical analysis was performed using SPSS version 22. Results: Out of 350 participants, 214 were females and 136 were male. Most participants (106, 30.5%) were between the ages of 18 and 30 years. The majority of patients (98.3%) reported dentine hypersensitivity, most frequently associated with mandibular posterior teeth (28.0%). Attrition (45.7%) emerged as the predominant tooth wear contributing factor, showing a weak but statistically significant negative correlation with VAS scores (p = 0.01), suggesting that isolated attrition was associated with slightly lower reported pain levels. In contrast, the overall severity of tooth wear showed a moderate positive correlation with VAS scores (p < 0.001), indicating that greater cumulative tooth wear severity was associated with increased pain perception. Sensitivity to hot and cold foods and pain on breathing with gritted teeth were significantly associated with higher VAS scores. The frequency of sugar-rich beverage intake showed a trend toward higher sensitivity (Linear-by-Linear Association p = 0.030), although the overall association was not statistically significant. Conclusion: Tooth wear was significantly associated with dentin hypersensitivity severity, and the extent of wear was positively correlated with the intensity of sensitivity.
Objective: To develop and establish the content validity of an assessment blueprint for the neuroanatomy module of undergraduate medical students using the Modified Delphi technique. Methods: A multiphase study incorporating a Modified Delphi for assessment blueprint was conducted following IRB approval. Phase I comprised learning outcomes (LOs) selection and categorization. In Phase II, item- and scale-level content validity indices (I-CVI, S-CVI) were calculated. Phase III involved two Delphi rounds to achieve expert consensus on LOs impact and frequency scores (1-3). In phase IV, consensus scores were used to assign weights to LOs in assessment blueprint development, and content validation using CVI. Results: Twenty-five LOs were identified; 21 were retained following content validation (I-CVI ³ 0.78; S-CVI=0.90). In Delphi round 1, 57% (12/21) and 67% (14/21) of LOs showed no consensus for impact and frequency, respectively, while strong consensus was achieved for 14% (3/21) and 10% (2/21). In round 2, all LOs (100%) reached at least an acceptable consensus. Strong consensus increased to 76% (16/21) for impact and 71% (15/21) for frequency, with no LOs remaining without consensus. The resulting blueprint demonstrated content validity (I-CVI=1.00). Conclusion: The multiphase approach, combining CVI evaluation with Delphi consensus, outlines a framework for blueprint development. The Delphi process enables expert-derived impact and frequency scoring of learning outcomes, supporting their relative weighting and contributing to the establishment of content validity.
Objectives: Mental health disorders such as anxiety, depression, and stress-related conditions contribute significantly to global disease burden, including in Pakistan where socioeconomic instability, stigma, and limited access to services worsen outcomes. Lifestyle interventions have emerged as promising non-pharmacological strategies for promoting psychological well-being. This systematic review evaluated the impact of lifestyle interventions on mental health outcomes within Pakistani populations from January 2020 to April 2025. Methodology: A systematic search was conducted across PubMed and Google Scholar for peer-reviewed studies assessing at least one lifestyle intervention (e.g., physical activity, diet, mindfulness) and reporting at least one mental health-related outcome (e.g., stress, anxiety, depression, or psychological well-being). Study selection followed PCC criteria and PRISMA guidelines. Results: Twenty-one studies met initial eligibility, of which ten were verified as interventional with measurable mental health outcomes and were included for synthesis. Across studies, interventions involving physical activity, nutrition modification, mindfulness, and culturally adapted cognitive-behavioral techniques demonstrated positive effects on stress, anxiety, depression, mood, sleep, and coping. Study designs primarily included randomized, quasi-experimental, and feasibility trials. Risk of bias was generally moderate due to methodological constraints, shorter durations, and self-reported outcomes. Conclusion: Pakistani evidence supports the beneficial role of lifestyle interventions in improving mental health outcomes, aligning with international findings and highlighting scalable, low-cost approaches relevant to resource-constrained settings. Integration into primary care, educational, and community settings represents a promising avenue for mental health promotion in Pakistan.
Objective: To assess the effectiveness of personalized dietary counseling and regular nutritional monitoring in improving cancer-related cachexia among women with breast cancer, using the validated Mini-Cancer Cachexia Score (Mini-CASCO). Methodology: A parallel, single phase, two-arm interventional study was conducted at Fauji Foundation Hospital, Rawalpindi from June to December 2024. A total of 134 participants were randomized in a 1:1 ratio using block stratified allocation to either an intervention group (n=67), which received standard oncologic care supplemented with individualized dietary counseling and nutritional monitoring every 15–21 days, or a control group (n=67), which received standard care alone. The magnitude and severity of cachexia was assessed at baseline and 6 months using Mini-CASCO across five domains including body composition, inflammatory-metabolic profile, physical performance, appetite, and quality of life. Results: Of 134 participants enrolled, 130 (97%) completed follow-up. After 6 months, the intervention group demonstrated a significant reduction in overall Mini-CASCO score (Δ=−14.4 ± 5.1; p<0.01; Cohen’s d=2.0), whereas the control group showed only a small decrease (Δ=−2.6 ± 4.9; p=0.03). Between-group analyses demonstrated significant improvements attributable to the intervention across all Mini-CASCO domains, including body weight/composition (Δ=−5.2 ± 2.6), inflammatory–metabolic profile (Δ=−2.5 ± 1.5), physical performance (Δ=−1.8 ± 1.1), appetite/anorexia (Δ=−1.9 ± 1.0), and quality of life (Δ=−1.0 ± 0.7) (all p<0.001). The overall effect size was large (partial η²=0.38), indicating strong clinical relevance. Conclusion: Incorporating structured dietary counseling and nutritional monitoring into routine oncology care significantly attenuates cachexia and enhances functional, metabolic, and psychosocial outcomes in women with breast cancer. Mini-CASCO functioned effectively as an outcome tool for monitoring therapeutic response, supporting nutrition-sensitive strategies within cancer care pathways.
Objective: To compare motor outcomes and postoperative complications of subthalamotomy versus pallidotomy for Parkinsonian rigidity in a resource-limited setting where deep-brain stimulation is not affordable. Methodology: This quasi-experimental study was carried out at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, from 2016 to 2021. Forty patients with Parkinson’s disease were included. Twenty patients underwent pallidotomy, in which a small, precisely targeted lesion was made in the globus pallidus region of the brain, and twenty had a subthalamotomy, involving a lesion in the subthalamic nucleus. Each patient’s motor function was assessed before surgery and at regular follow-ups using the Unified Parkinson’s Disease Rating Scale (UPDRS) part III, a standard measure of movement difficulty in Parkinson’s disease. Postoperative complications were also recorded. The changes in UPDRS scores and complications were compared within and between groups. Results: The mean age was 47.6 ± 8.7 years, and 85% of patients were male. Both procedures produced significant postoperative improvement in motor scores (p < 0.001). In the pallidotomy group, the UPDRS Part III score improved from 24.9 ± 1.47 to 10.47 ± 0.86 (42% improvement), and in the subthalamotomy group from 25.48 ± 1.55 to 10.26 ± 1.18 (40.2% improvement). Although pallidotomy showed a slightly greater numerical reduction in UPDRS scores, the difference between groups was not statistically significant (p > 0.05). Complications were less frequent after pallidotomy (10%) compared with subthalamotomy (35%), but this difference was not statistically significant. Conclusion: Both procedures are effective in treating Parkinsonian rigidity. No statistically significant difference was observed between the two procedures in terms of relief of symptoms. Fewer complications were associated with pallidotomies as compared with subthalamotomies.
Objective: To characterize the microbiological spectrum and antibiotic susceptibility patterns of pathogens causing empyema thoracis in adults at a tertiary care hospital in Lahore, and to describe the prevalence and temporal trends of multidrug-resistant (MDR) isolates. Methodology: This observational study comprises 581 cases of bacterial empyema thoracis in patients admitted to the Thoracic Surgery Department, Services Hospital, Lahore, Pakistan, from March 2023 to February 2025. We collected the patient’s demographic data, culture results, and patterns of antibiotic sensitivity and resistance. Adults aged ≥18 years were included in the study. Descriptive variables were analyzed as means and frequencies. An independent t-test was applied to compare resistance to antibiotics in gram-negative and gram-positive organisms. Results: This study includes 581 cases of empyema thoracis, out of which 527 cases show positive bacterial culture growth and 54 cases show no growth on culture. From a total of 527 bacterial cultures, 274 (52%) were Multidrug-resistant (MDR). Multidrug-resistant prevalence fluctuated across half-year periods, ranging from 53.7% to 62.7%. Among positive cultures; most common Bacteria isolated was Pseudomonas aeruginosa in 167 (32%) patients, this was followed by Klebsiella pneumonaie in 51 (10%), Acinetobacter species in 47 (9%), E. coli in 48 (9%) and other gram negative organisms. Meropenem shows the highest sensitivity followed by gentamycin. Conclusion: Empyema thoracis remains prevalent in our country and is now more commonly associated with gram-negative organisms. Antibiotic resistance is increasing alarmingly, producing Multidrug-resistant pathogens upto 62% in our study.
Objective: Dermatological manifestations are common but under-recognized complications of chemotherapy in children, particularly in low- and middle-income countries (LMICs) such as Pakistan where supportive care systems are limited. This study prospectively assessed the spectrum and onset of dermatological toxicities in pediatric cancer patients at a tertiary care center in Pakistan. Methodology: A prospective cohort study was conducted from March to December 2023 at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS) Islamabad, Pakistan. Sixty-eight children (aged 1–13 years) with cancer receiving chemotherapy were enrolled and systematically examined for dermatological manifestations at each cycle by a dermatologist. Dermatological toxicities such as skin, hair, and nail changes were recorded using standardized clinical definitions, and infections were confirmed by microbiological or histopathological testing when indicated. Associations with demographic and treatment characteristics were analyzed using chi-square tests. Results: Overall, 86.7% of patients developed at least one dermatological toxicity. Nail changes were most frequent (69.1%), followed by skin (57.4%) and hair changes (42.6%). Common findings included Beau’s lines (30.9%), maculopapular rash (16.1%), and complete alopecia (25.0%). Most dermatological toxicities appeared within 30 days of treatment initiation and only 7.3% of dermatological toxicities led to temporary treatment delay. Younger children (1–5 years) and those on continuous chemotherapy regimens experienced significantly higher rates of dermatological toxicities (p-value < 0.05). Secondary infections occurred in 29.4% of patients, with viral etiologies predominating. Conclusion: Dermatological manifestations are highly prevalent and often occur early in pediatric cancer patients receiving chemotherapy, particularly among younger children and those on continuous regimens. Routine dermatological surveillance and timely management should be integrated into pediatric oncology supportive care in Low- and middle-income countries to minimize morbidity and treatment disruption.
